1. Forty -two cases of congenital morbus cordis are
reported with detailed observations on 15 selected
2. The supposed rarity and extreme gravity of the
lesion is doubted, it being shown how the clinical
signs may be out of all proportion to the anatomical
3. Etiology: - A familial tendency to congenital
heart disease is admitted - rare cases being reported
from the literature and one from the writer's experience.
It is not thought that there is any significant
tendency to parental transmission of acquired
organic morbus cordis. Syphilis is undoubtedly a
causal factor but not to the extent believed by the
French writers. The effect of alcohol is theoretical
and the incidence of consanguinity is estimated to be
little higher than that of the whole population. The
frequent co- existence of visceral and cardiac anomalies
and the types of certain congenital cardiac defects
suggest that many are developmental in their inception.
4. The physical standard, apart from the cyanotic
group and the graver anomalies, is little affected nor
is the standard of response to education. Comparisons
are made with consecutive series of normal children and
sufferers from morbus cordis of rheumatic origin.
5. The theories of the causation of cyanosis are
reviewed, its etiology being seen to be dependent on
certain "determining factors", namely the degree of
shunt present, the efficiency of pulmonary oxygenation
and oxygen reduction in the tissue capillaries.
6. The importance óf cardioradiology is stressed.
A description of the normal cardiac shadow^ the respective
merits of teleoradiography, percussion and
palpation in determining the size of the heart are
given. It is shown that the conception of increase
in the heart size is arbitrary, it being affected by
the position of the heart in the thorax, the shape of
the heart and its relationship to the chest size.
The radiographical appearance of the pulmonary artery
in its relationship to the oesophagus is described.
7. Defects of the auricular septum are common and
in the majority of instances "silent ". Closure of
the septum is described as occurring at any date from
two weeks to two years after birth, 83.8% closing by
the end of the first 10 weeks, and 5.7% being still
patent at the end of the first year. The foramen
ovale is the common site of patency, defects of the
upper and lower parts being rare and complicated by
other anomalies in adjacent cardiac structures. With
gross defect cyanosis may be present, one case of
which is described (Case No.15, vol.2, p.50), and
physical and mental development be seriously interfered with. In the major number it is clinically silent
and only demonstrable on X -ray examination.
8. Maladie de Roger is, apart from defect of the
auricular septum, the commonest of congenital cardiac
lesions. The site of election is at the base of
the interventricular septum, but may occur elsewhere.
In 80% of cases the site of maximal intensity of the
bruit lies between the third and fourth intercostal
space; it is harsh and high pitched and is conducted
transversely and to the back. Thrill is not constant,
being absent in two cases in the present
series of 9. The radiological picture is characteristic, namely the globular appearance of the heart.
The appearance of the conus of the right ventricle
and of the pulmonary stem is described, the former
is thought to be dilated and in many cases the
pulmonary artery also. The diagnostic point is
thought to depend on the X -ray picture, and the intensity
of the pulmonary second sound; a dilated "pulmon-
ary arc" with an accentuation of the pulmonary second
sound being indicative of a dilatation of the pulmonary
stem, whilst a similar radiological appearance
when associated with a normal pulmonary second sound,
suggests dilatation of the conus of the right ventricle.
Cyanosis is rare, but may occur as either a temporary
or a terminal feature. The bruit is to be diagnosed
from exocardial and other systolic murmurs of unknown
origin, mitral and aortic stenosis and Eisenmenger's
9. "Pulmonary stenosis". The more fitting name of
Pulmonary Obstruction is given, it being believed that
the clinical signs of pulmonary stenosis and atresia,
whether developmental or inflammatory in origin, and
the effect on the cardiac septa, are solely determined
by the degree and date of obstruction at the pulmonary
valve. The condition classified and described according
to this conception.
a) Pulmonary obstruction with closed cardiac septa is
;held to be in all instances inflammatory in origin.
The pulmonary artery is small or very rarely dilated.
The characteristic clinical signs are those of cardiac
right side enlargement, a systolic bruit heard over
the pulmonary valve and carried up towards the left
clavicle and in 50% of cases thrill.
b) Fallot's Tetralogy comprises the largest group of
defects as associated with obstruction at the pulmonary'
valve. Cyanosis is persistent, a count of 13,470,000
being reported; the incidence of thrill varies from
9.1% to 16.5% of cases. The radiological picture is
characteristic, namely, a concavity of the upper left
cardiac margin an enlarged right heart surmounted by
an aorta whose shadow is broad and extends unduly to
the right. The freedom of the oesophagus from pressure
by the pulmonary artery and its increased liability to
pressure from the dilated aorta is shown. The auscultatory
features are described and the insignificance
of a carotid bruit is stressed.
c) A description of the various types of pulmonary
imperforation is given.
10. Prognosis is held to depend on :-
(1) The local mechanical effects of the lesion.
(2) The pathological conditions to which the subject
is more liable by reason of the cardiac defect, viz:
bacterial endocarditis in about 33.4% of cases, pulmonary
tuberculosis, bronchitis, bronchopneumonia and
(3) The response of the individual to certain
physiological events such as pregnancy and puberty.
11. Treatment of Congenital Morbus Cordis is threefold.
a) To prevent intermarriage of and procreation from
those persons whose type is believed to favour the
incidence of congenital heart disease - alcoholics,
syphlitics and congenital syphlitics, blood relations,
mental defectives etc; parental acquired heart disease
is not thought to play a part.
b) To guard the patient against any condition which
might raise the pressure of the lesser circulation and
to keep him within the limits of his cardiac reserve
c) To have recourse to the free use of oxygen and warmth in emergency.
Recent advances in surgical treatment of congenital valvular defects and the intra-arterial and
intravenous use of oxygen are referred to.